An adolescent with severe neurogenic pulmonary oedema after spontaneous cerebellar haemorrhage

This report presents a patient who developed fulminant pulmonary oedema as a complication of spontaneous cerebellar haemorrhage. In spite of persisting hypoxaemia under ventilation with high levels of Fi02 and PEEP, it was decided to proceed with a surgical evacuation of the haematoma. Fortunately, after the patient was turned to the prone position, oxygenation improved rapidly. This observation suggests that prone ventilation can be a valuable tool in de treatment of neurogenic pulmonary oedema (NPE). This report also comprises an overview of pathophysiology, diagnostic measures, monitoring and treatment of NPE. Although the exact mechanism remains unclear, there is growing evidence that NPE is caused by a pressure overload mechanism, which is supported by this case.